Nurse Anesthetists Don't Measure Up

By JAY EPSTEIN

Tuesday

Jul 2, 2013 at 12:01 AM

Here's a telling statistic: When anesthesiologists are involved, there are seven fewer deaths for every 10,000 patients put to sleep. Those numbers matter.

Our state is faced with a need to expand access to health care within a system that already has significant challenges.Expanding the role of nurse anesthetists into administering anesthesia has been suggested. An op-ed column, "Health System Must Be Sustainable," June 25, by Bruce Weiner did so, for example. However, rational review of the data does not support nurse anesthetists in the dangerous arena of administering anesthesia as a solution to this problem.It is correct that physician "extenders" such as nurse anesthetists are being contemplated for an increased role in the delivery of medical care. Policymakers need to consider three critical factors when they are presented with these doctor alternatives:1. Does the expansion of care by nonphysicians jeopardize public safety?2. Does this move really save money?3. Is there a true care-provider shortage that needs to be addressed?When measured up, this proposition — equalizing anesthesiology doctors and anesthesia nurses — falls drastically short on all three counts.On the first criterion, there is no doubt that patient safety will be jeopardized by replacing a physician anesthesiologist with an anesthetist nurse who has at best half the amount of advanced medical training.While nurse anesthetists are well-respected and highly regarded members of the anesthesia-care team, their level of training and experience — critical elements in the highly complicated areas of anesthesia, intensive care and interventional pain medicine — do not match that attained by their supervising physicians.The direct participation of anesthesiology doctors dramatically changes patient outcomes vs. care provided by a nurse anesthetist only. Every scientific study to date demonstrates that anesthesiologists, when directing the anesthesia team or performing the anesthetic themselves, do so at lower complication and death rates than an anesthetist providing comparable care alone.Here's a telling statistic: When anesthesiologists are involved, there are seven fewer deaths for every 10,000 patients put to sleep. Those numbers matter.That brings me to the second element: Do anesthesia nurses save the system money?No, for two primary reasons:Most medical insurers charge the same amount for an anesthesia-related procedure, regardless of who administers it. So putting the nurse on equal footing with a physician will not save insurance dollars.Further, putting anesthetists in a collaborative role with physicians would increase costs because of the fact that, more — not fewer — physicians would need to be consulted and more costly tests would most likely be performed.When bad outcomes occur, the expenses to remedy that situation — setting aside the human tragedy that comes with such an event — can often cost tens of thousands of dollars, if not more.Increasing the independence of CRNAs would compromise the safety of patients — and that will end up costing everyone more in the long run.Finally, is there a true shortage of anesthesia providers that needs to be addressed?Not really.Florida does need more physicians and this shortfall is likely to worsen as we expand access under the Affordable Care Act. But that shortage exists in areas such as primary care, not in specialties such as anesthesia or interventional pain medicine.As more consumers have access to health insurance and preventive care, the need for surgical procedures or other interventions may decrease.There is no doubt that the supply of anesthesiology doctors has kept up with the demand for their services.To verify this, the Florida Society of Anesthesiologists in 2012 surveyed every hospital in the state to determine if there was a need for additional staff in their anesthesiology departments. Not one hospital responded that they were short anesthesiology doctors or mid-level-provider anesthetists.Medical care in the United States is appropriately under microscopic review, but any changes to the health care system need to be justified as safe, cost-effective and necessary.An increased scope of practice for anesthesia nurses is not needed and fails to accomplish any of these goals. In fact, this idea would expose the citizens of our state to more risk at greater expense.

[ Dr. Jay Epstein of Clearwater is an anesthesiologist who is board certified in anesthesiology and critical-care medicine. He is president of the Florida Society of Anesthesiologists, Miami. ]

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